Children placed with a relative after being removed from their home for maltreatment have fewer behavioral and social skills problems than children in foster care, but may have a higher risk for substance use and pregnancy as teenagers, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. These relatives -- known as kinship caregivers -- appear more likely to be single, unemployed, older, and live in poorer households, yet receive fewer support services than do foster caregivers.

Most children who are removed from the care of their parents live with non-related foster parents, according to background information in the article. However, the number of children placed in kinship care is growing, and more than 125,000 children currently live in a relative's care. The increase is due to a decline in the number of foster homes at the same time that demand for out-of-home placements has increased. "Despite the move toward kinship care, the evidence for improved outcomes of children in kinship care vs. foster care has been conflicting," the authors write.

Christina Sakai, M.D., and colleagues at University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, studied 1,308 children entering out-of-home care after reported maltreatment. Of these, 572 were placed in kinship care and 736 in foster care. At the beginning of the study and after three years, researchers conducted face-to-face interviews and assessments of children's behavioral and mental health and health service use, along with caregivers' receipt of services such as financial support, parent education and training, peer support groups and respite care.

Kinship caregivers were more likely than foster parents to have a low socioeconomic statusthey were four times more likely not to have graduated high school and three times more likely to have an annual household income of less than $20,000. However, they were less than half as likely as foster parents to receive any form of financial support, about four times less likely to receive any form of parent training and seven times less likely to have peer support groups or respite care.

At the three-year follow-up, children in kinship care were more likely to be with a permanent caregiver than were children in foster care (71 percent vs. 56.4 percent). They also had 0.6 times the risk of behavioral and social skills problems and half the risk of using outpatient mental health services or taking psychotropic medications. However, adolescents in kinship care had seven times the risk of pregnancy (12.6 percent vs. 1.9 percent) and twice the risk of substance abuse (34.6 percent vs. 16.9 percent).

"Our findings indicate that kinship caregivers need greater support services," the authors write. "The findings also indicate that kinship care may be associated with a reduced risk of ongoing behavioral and social skills problems and decreased use of mental health therapy and psychotropic medications. Conversely, adolescents in kinship care have higher odds of reported substance use and pregnancy. These findings suggest that increased supervision and monitoring of the kinship environment and increased caregiver support services are urgently needed to improve outcomes of children in kinship care."